Treatment for Self-Harm

What is Self-Harm ?

Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidalintentions. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The older literature, especially that which predates the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), almost exclusively refers to self-mutilation. The term is synonymous with "self-injury".


Write Self-harm behaviour

a) burning,
b)scratching,
c)banging or
d)hitting body parts,
e)interfering with wound healing,
f)hair-pulling (trichotillomania) and the
g)ingestion of toxic substances or objects.

Cutting types:
Small, linear cuts. "The most typical cuts are very linear, straight line, often parallel like railroad ties carved into forearm, the upper arm, sometimes the legs," Rosen tells WebMD. "Some people cut words into themselves. If they're having body image issues, they may cut the word 'fat.' If they're having trouble at school, it may be 'stupid,' 'loser,' 'failure,' or a big 'L.' Those are the things we see pretty regularly."

Write names of psychiatric disorders where in self-harm behaviour is noted.

Self-harm is listed in the DSM-IV-TR as a symptom of borderline personality disorder. However patients with other diagnoses may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders.

Causes
Mood changes like depression or anxiety, out-of-control behavior, changes in relationships, communication, and school performance. Kids who are unable to manage day-to-day stresses of life are vulnerable to cutting,

Abuse during childhood is accepted as a primary social factor increasing the incidence of self-harm,

Treatment

PsychotherapyKnown as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injuring behavior. Therapy can also help you learn skills to better manage distress, help regulate your impulsiveness and other emotions, boost your self-image, better your relationships, and improve your problem-solving skills.

Several types of individual psychotherapy may be helpful, such as:

• Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
• Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others.
• Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination guided by a therapist.
• Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being.

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

MedicationsThere are no medications that specifically treat self-injuring behavior. However, your doctor may recommend treatment with antidepressants or other psychiatric medications to help treat depression, anxiety or other mental disorders commonly associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.

Psychiatric hospitalizationIf you injure yourself severely or repeatedly, your doctor may recommend that you be admitted to a hospital for psychiatric care. Hospitalization, often short term, can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.

Avoidance techniques
Generating alternative behaviours that the sufferer can engage in instead of self-harm is one successful behavioural method that is employed to avoid self-harm.Techniques, aimed at keeping busy, may include journaling, taking a walk, participating in sports or exercise or being around friends when the sufferer has the urge to harm themselves. The removal of objects used for self-harm from easy reach is also helpful for resisting self-harming urges.[16] The provision of a card that allows sufferers to make emergency contact with counselling services should the urge to self-harm arise may also help prevent the act of self-harm. Alternative and safer methods of self-harm that do not lead to permanent damage, for example the snapping of a rubber band on the wrist, may also help calm the urge to self-harm.Using biofeedback may help raise self-awareness in the sufferer of certain pre-occupations or particular mental state or mood that precede bouts of self-harming behaviour,and help the sufferer identify techniques to avoid those pre-occupations before they lead to self-harm. Any avoidance or coping strategy must be appropriate to the individual's motivation and reason for harming.

Ref: http://en.wikipedia.org/wiki/Self-harm



Aetiology

Tribal Education - Survey findings and Suggestions

The National policy on Education for Tribals seeks to bring Scheduled Tribes into the mainstream of society through a multi-pronged approach for their all-round development without disturbing their distinct culture.



There are 67.8 million Scheduled Tribe people, constituting 8.08 per cent of India’s population.  There are 698 Scheduled Tribes spread all over the country barring States and Union Territories like Chandigarh, Delhi, Haryana, Pondicherry and Punjab.  Orissa has the largest number – 68--of Scheduled Tribes. Scheduled Tribes are those which are notified as such by the President of India under Article 342 of the Constitution.  The first notification was issued in 1950.  The President considers characteristics like the tribes’ primitive traits, distinctive culture, shyness with the public at large, geographical isolation and social and economic backwardness before notifying them as a Scheduled Tribe.  Seventy-five of the 698 Scheduled Tribes are identified as Primitive Tribal Groups considering they are more backward than Scheduled Tribes.  They continue to live in a pre-agricultural stage of economy and have very low literacy rates. Their populations are stagnant or even declining. 

   National policy on tribals follow five principles of Nehruvian Panchasheel, spelt out in 1952. They are:

1. Tribals should be allowed to develop according to their own genius.
2. Tribals’ rights in land and forest should be respected.
3. Tribal teams should be trained to undertake administration and development without too many outsiders being inducted.
4. Tribal development should be undertaken without disturbing tribal social and cultural institutions.
5. The index of tribal development should be the quality of their life and not the money spent.

Realising that the Nehruvian Panchasheel was long on generalities and short on specifics, the Government of India formed a Ministry of Tribal Affairs for the first time in October 1999 to accelerate tribal development.  Based on the feedback from tribal leaders, the concerned States, individuals, organisations in the public and the private sectors, and NGOs, the Ministry recognises that a majority of Scheduled Tribes continue to live below the poverty line, have poor literacy rates, suffer from malnutrition and disease and are vulnerable to displacement.   It also acknowledges that Scheduled Tribes in general are repositories of indigenous knowledge and wisdom in certain aspects. By observing alienation from the society, lack of adequate infrastructure like schools, hostels and teachers, abject poverty and apathy towards irrelevant curriculum, National ensures following policies:

1. Tribals are included in the national programme of Sarva Shiksha Abhiyan run by the Ministry of Human Resource Development.
2. Schools and hostels are opened in areas where no such facilities exist.
3. At least one model residential school is located in each tribal concentration area.
4. Education is linked with provision of supplementary nutrition.
5. Special incentives like financial assistance, pocket allowance, free distribution of textbooks and school uniforms are provided .
6. Teaching is imparted in tribals’ mother tongue at least up to the primary level. Educated tribal youth are given employment as teachers, wherever possible. (This will obviate the need to employ teachers belonging to far-off places who find commuting is as difficult as staying in a village with no basic amenities.
7. Pedagogy is made relevant so that tribals do not find it as alien.
8. Curriculum and cocurriculum include aspects of meta skill upgradation of tribal children. 
9. Curricula for meta skill upgradation are to include aspects of tribal games and sports, archery, identification of plants of medicinal value, crafts art and culture, folk dance and folk songs, folk paintings etc.
10. Emphasis is laid on vocational/professional education.  Polytechnics are set up for studies in subjects like forestry, horticulture, dairying, veterinary sciences, polytechnics.

To sum up, the policy endorses paradigm shift in primary education for the tribal population. It restricts  enforcement of formal education on the scheduled tribes rather suggests some measures so that they feel inner motivation to the schooling. One of the important social objective of education is to equalize opportunity. It enables the backward or under privilege classes or individuals to use education as a lever for the improvement of their condition. Tripura and Manipur – two north eastern states of India possess literacy 

rates which are above the national average. Again illiteracy and dropout rates among the scheduled tribe students of both states are also very high. This contradiction complicates the issue of understanding about reading and writing motivation of ST students in primary education of both states. On this background, current study aimed at two objectives – (a) to examine pattern of relative preferences to Reading and Writing motives of students in primary education across  different tribal communities of Tripura and Manipur, (b) to explore effect of some situational variables  and student characteristics on  changes in relative preferences to reading and writing motives of students  in primary education across  different tribal communities of Tripura and Manipur. Data were collected through Reading and Writing motivation questionnaire (Dutta Roy, 2003) from scheduled tribe students of Tripura (N=275) and Manipur (N=284) living in different hill districts. Based on the results, following suggestions are made. 

1. Link syllabus of primary education with economic activities or vocational education. Vocational education should be in conformity with suitable family occupation and family culture of hill people. It will help them to understand importance of syllabus.
2. Find out local resource persons with expertise in specific vocational education, train them in teaching students and involve them as resource persons of schools.
3. Avoid lesson contents and pictures which are related to development of urban mind set. This will help to stop migration to urban areas and will help the hills for socio-economic development after formal schooling. As I noticed feeling of alienation to hill cultures among the people trained with formal schooling in hills. Furthermore, it will reduce some unemployment problems in valley areas.
4. Health related issues like major diseases, first aids, safety can be added in the syllabus.
5. School syllabus should give much emphasis on drawing, conversation, dictation, sports, drama etc.
6. Explore rich culture and heritage, folk tales of tribal people and include them in syllabus. It will reduce their tribal identity crisis.
7. In teaching to students, relate knowledge with other knowledge (e.g., relate knowledge of river to the life and later to the socio-economic development of areas) rather knowledge as entity. Most of the schools follow later method of teaching. Again, problem solving method in teaching is not followed. This results lack of development of creativity impulse among the students. So, problem solving method should be introduced in teaching.
8. Schools possess economic dependency on the Government. Lead the schools to explore some possibilities to find out more economic independence using their own resources. They can use their information sharing resources (school exhibits, magazines, library and computers, school sports, drama etc.) for economic independence. For this purpose, area wise school clusters can be formed.

9. Involve the community in various development programmes of schools so that communities can understand that school is an instrument for change in their socio-economic development.

Family climate scale

Family climate scale

The article reports on the development of the Family Climate Scales (FCS) questionnaire. The FCS is a multilevel, self-report, whole-family index of aspects of family culture and process for use in nonclinical settings with families where the children may be adults. It was designed to be particularly but not exclusively applicable in the context of family business. 

The FCS measures on six scales: Open Communication, Adaptability, Intergenerational Authority, Intergenerational Attention to Needs, Emotional Cohesion, and Cognitive Cohesion. Results indicate very high levels of internal consistency. 

Sub-scale inter-correlations are also high, with the exception of the Intergenerational Authority sub-scale. Analyzes using structural equation modeling confirmed the hypothesized six-factor structure of family climate. No significant differences in family climate were found between business/nonbusiness families in the sample. Other relationships in the data set lend support to the validity and usefulness of the measure. Implications for family business theory/research and practitioners are discussed.

Ref: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1004913